Salford Royal Hospitals NHS Trust

Salford Royal Hospitals NHS Trust wanted to take full advantage of electronic patient records without the wholesale replacement of existing departmental systems. Using the latest healthcare solutions from Microsoft partner iSOFT, information from a dozen systems is now organised in structured electronic documents that give an at-a-glance view of a patient, their history and other critical medical information. GPs and staff in community care can also view this data, improving the accuracy and timeliness of patient care across the whole of the region. When the Trust migrates to iSOFT’s LORENZO healthcare solution as part of the National Programme for IT in England (NPfIT), it will be able to plan and share resources with other NHS organisations, and healthcare professionals can engage in live, online collaboration with their peers and specialists.

Situation
Salford Royal Hospitals NHS Trust (Salford) is a 900-bed university hospital in the City of Salford in the North West part of England. Like all healthcare organisations in the UK National Health Service (NHS), the Trust is working towards aligning its systems and processes with the NPfIT. The Programme's fundamental aim is to support measurable improvements in patient care and overall operational efficiency by increasing the availability and exchange of information across organisations and wider healthcare economies.

Dr Bob Young, Consultant Physician and Medical Director (Clinical Effectiveness, Salford Royal Hospitals NHS Trust) sums up the challenge facing the Trust: “Much of healthcare is constrained by where the patient information actually resides. You can’t carry out a successful healthcare encounter unless you’ve got an accurate, up-to-date patient record.”
This is the issue facing most healthcare organisations. Patient information resides on a variety of systems – paper-based and electronic – and combining that information into a single, structured record is extremely difficult. In Salford’s case, there were dozens of departmental systems of varying degrees of sophistication. Dr Young explains, “On the one hand we had desktop computer databases based on generic PC software. In other cases, departments invested in commercial standalone systems or developed them internally. But we had no way of combining information from all these systems into a single patient record.”

Salford wanted to go one step further. As well as developing a centralised electronic patient record (EPR) system for the Trust, it wanted to share this information with other healthcare professionals, including General Practioners (GPs) and community care workers. Says Dr. Young, “A good example is diabetes, where the quality of patient care is determined by the ability to share patient information quickly and accurately between acute care, GP, and a community diabetes nurse. Any solution had to connect all the stages in the patient journey.”

Ultimately, the Trust will align all its systems with NPfIT, one of the largest civil IT projects in the world. “Any solution had to be compatible with the NPfIT objectives and support a clear roadmap for alignment over the next few years,” says Dr. Young.

LORENZO solutions
The Trust embarked on the initial phase of the project by working on integrating the first of many stand-alone patient systems. The first decision involved acquiring clinical management software from iSOFT (formerly Eclipsys SCM) that supports the Trust's decision making with instant access to up-to-date results and other critical patient data. This was the first step in what will lead to the full implementation of LORENZO, iSOFT's holistic healthcare solution.

LORENZO incorporates a comprehensive set of applications, workflow, and rule engines, together with integration tools that fully address the needs of all participants in the delivery of care, and has been selected as one of the main components of the Connecting for Health programme. The solution will eventually support the needs of almost 30 million citizens in three of the UK’s five national Connecting for Health regions, delivering:

Lifelong electronic records for every citizen in the UK
Clinician online access to these records, whatever their location
The sharing of information among GPs, hospitals and community services
Citizen access to online services and telemedicine
Information to ensure that health planners and managers use NHS resources effectively

Dr. Young adds, “By implementing iSOFT’s clinical management software, we have a head start in most of these areas, especially in the consolidation and sharing of patient information to support better decision making. It also means that we can smoothly transition to the full LORENZO solution as part of our alignment with NPfIT.”

The Trust’s informatics team worked with iSOFT to identify the most suitable systems to be interfaced as part of a pilot scheme. They chose an iSOFT Patient Admission System (PAS) (previously known as Torex PatientCentre) that already existed within the Trust, as well as the pathology and radiology databases. Integration was tested on eight elder-care wards where patient information typically refreshes more slowly, making it easier to control and monitor pilot results. The pilot was so successful it was quickly made available across the entire hospital network, which means that anyone with authorised access and a connected PC could view information relating to the patients in the elder-care wards.

Subsequently, many other internal systems have been interfaced to or re-provided within the core clinical manager solution, including:

The Trust’s external correspondence system used by secretaries and administrative staff
Pharmacy
Clinical resource booking and scheduling system
Accident and Emergency
Maternity – deliveries
Palliative care
Infection Control
Endoscopy
Bronchoscopy
Diabetes

Microsoft technology is utilised in the delivery of LORENZO. The Trust’s existing iSOFT clinical management system’s core database and operating system technology use a series of Microsoft® SQL Server™ 2000 databases to store data, while Microsoft Windows Server System™ manages and orchestrates the operational functionality. In addition, Microsoft is a key partner in the delivery of the wider integration and development tools that support LORENZO and the creation of specialist healthcare applications that lie at the heart of the solution.

Benefits
Improved patient care
Clinical staff at Salford now have immediate access to real-time, comprehensive, electronic patient records. In some specialties, as much as 95 per cent of the results, notes, and correspondence can be called up from the EPR on-screen, so some consultations are entirely paper free.

Similarly, much of the information needed to support inpatient management is now most readily accessed from the EPR. Discharge summaries, including the accompanying 'take-home' prescriptions, are all created in the clinical management system. This reduces time spent on administration and ensures prompt, legible, and accurate information for GPs and patients.

A seamless patient journey
GPs and staff working in community care can now view the Acute Trust EPR in their own surgeries and clinics. The ability to view discharge notes in a structured, consistent format is extremely valuable to GPs, who can organise follow-up appointments safe in the knowledge that all the information they need will be ready for the patient.

Community care staff enjoy similar benefits. They get an immediate view of assessments made before discharge of the patient. From their perspective, it is also critical that they know where the patient is. For example, last-minute changes to hospital schedules or faster-than-expected recoveries can alter the original timetable of patient stays. Now they can see up-to-the-minute information when they view a patient’s discharge notes.

Furthermore, these staff don’t need any special computer equipment other than a PC with a dial-up connection to view this data. Says Dr. Young, “Their response has been amazing. Most now say that there’s no way they could go back to working without this information.”

An incremental approach to healthcare renewal
Unlike other solutions that require hospitals to rip and replace their legacy applications, LORENZO supports an incremental approach to the renewal of healthcare systems. As a first step, you can integrate existing departmental systems with a centralised database. “With electronic patient records, you effectively start off with a blank page. But we were able to populate forms gradually. First with information from pathology and radiology and then other systems as soon as they were ready,” says Dr. Young.

In fact, one of the greatest challenges for Salford’s informatics team has been keeping up with demand from clinical staff all over the hospital. One of the system’s greatest strengths is that it’s very simple to use and most end-users immediately see the potential benefits, whatever their speciality.

“Confidence building is really important, especially in healthcare, where not every organisation has had a positive experience with new technology. But here, this simply wasn’t a problem. Even with the pilot, the system was starting to sell itself,” says Dr. Young. John Elliot, EPR Technical Analyst in Salford’s IT department, agrees. He says, “Almost immediately, other departments started recognising the potential of the system, and we had people knocking on the door asking if their own clinical data could be included.”

Taking the wireless approach
The delocalisation of healthcare information has obvious benefits, especially now that most of the Trust’s offices and departments have PCs connected to its network. But the Trust is taking this approach to its logical conclusion with the introduction of a wireless network.

“Doctors can now use wirelessly connected laptops running Microsoft Windows XP to access patient information during ward rounds. They can update patient notes during bedside consultations, effectively eliminating the paperwork and accuracy issues that sometimes occur during this process,” says Dr. Young.

Solutions for all healthcare settings
Looking to the future, the Trust is now confident that with iSOFT it has a technology partner that can support its strategic and technical roadmaps. Dr. Young is especially excited by the possibilities offered by LORENZO, which will eventually host all of the Trust’s data. “It means that we’ll be able to eventually retire all our old systems, reducing the expense of running and supporting many disparate technologies.”

Migrating to LORENZO will also offer a series of benefits that go beyond the integration of disparate patient data into a single record. LORENZO contains all the technologies and tools required to build any number of applications that support every activity across all healthcare settings, including the home.

Making citizens partners in healthcare
Patients will be able to book a slot with a GP using the Internet or digital television. The Trust will be able to send appointment reminders and other simple text messages to mobile phones and other devices.

National availability of patient records
Another important feature of LORENZO, and one of the main goals of NPfIT, is making electronic patient records available across the whole of the NHS. Says Dr. Young, “If someone from Salford collapses in Exeter, the nearest hospital will be able to access their records quickly and schedule appropriate treatment safe in the knowledge that they have everything they need to ensure the best outcome for the patient.”

More flexible resourcing
LORENZO will also support more flexible NHS resourcing. Dr. Young explains: “Imagine two hospitals 10 kilometres apart but in separate regions with their own healthcare systems. If the emergency obstetrics ward is full in one hospital, there’s no way of knowing if there are beds nearby, other than calling that hospital. Not only that, but you’d have to check with several people including the midwife, registrar on call, and a nurse in the special care baby unit. You can spend literally hours calling a directory of hospitals until you’ve found one that can give you all the information you need.”

When all hospitals are integrated with NPfIT, all these details will be available online. “LORENZO will even point you to the best hospital based on criteria such as specialist resources and the distance involved.”

Building confidence and momentum
Salford’s success sends a clear message to other hospitals and trusts. “Most people can understand the benefits of electronic patient records,” says Dr. Young. “But they remain to be convinced by the technology. We’ve shown that if you take an incremental approach, you can build confidence and momentum very rapidly.”

Most importantly, it puts the Trust in a perfect position to take full advantage of the NPfIT. “By implementing iSOFT’s clinical management software, we have a clear view of the rest of the benefits offered by LORENZO and NPfIT. This will have an enormous impact on our ability to deliver care. We achieved a great deal so far; the future is even more exciting.”

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Related link: LORENZO